In his new book Breakthrough! How the 10 Greatest Discoveries in Medicine Saved Millions and Changed Our View of the World Jon Queijo describes what he believes are the 10 greatest discoveries. 9 of them are uncontroversial discoveries that have been on other top-10 lists, but his 10th choice is one that no other list of top discoveries has ever included. He realizes that, and even admits in his introduction that a former editor of The New England Journal of Medicine refused to review his book because there is no such thing as alternative medicine, only treatments that work and treatments that don’t. But he “respectfully disagrees.”

Hippocrates’ discovery that disease had natural causes, sanitation, germ theory, anesthesia, X-rays, vaccines, antibiotics, genetics, and treatments for mental disorders are all worthy candidates for the list. But Queijo ludicrously lists the “rediscovery of alternative medicine” as the tenth “great discovery.” He presents no evidence (because there is no evidence) that alternative medicine has “saved millions” or that it has saved anyone. He doesn’t realize that alternative medicine represents a betrayal of exactly the kind of rigorous scientific thinking and testing that led to all the other discoveries. His list of ten breakthroughs is actually a list of 9 breakthroughs and one breakdown. (more…)

Mark Crislip is on vacation, but through an arduous series of shakings and succussions (beating his head against the wall?) we have channeled part of his essence: This post mostly concerns itself with infectious diseases, thanks to several recent posts on SBM that discussed the plausibility of health claims† and that touched on the recent discovery that most peptic ulcer disease (PUD) is caused by a bacterium, Helicobacter pylori. Several comments and statements quoted in those posts reveal recurrent questions regarding both plausibility itself and the history of the H. pylori hypothesis. In this post I’ll attempt to answer some of those questions, but I’ll also insert some new confusion.

Plausibility ≠ Knowing the Mechanism

Let’s first dispense with a simple misunderstanding: We, by which I mean We Supreme Arbiters of Plausibility (We SAPs) here at SBM, do not require knowing the mechanism of some putative effect in order to deem it plausible. This seems so obvious that it ought not be necessary to repeat it over and over again, and yet the topic can’t be broached without some nebbishy South Park do-gooder chanting a litany of “just because you don’t know how it works doesn’t mean it can’t work,” as if that were a compelling or even relevant rebuttal. Let’s get this straight once and for all: IT ISN’T.

One (dark and stormy?) night in 1882, a critically ill 70 year old woman was at the verge of death at her daughter’s home, suffering from fever, crippling pain, nausea, and an inflamed abdominal mass. At 2 AM, a courageous surgeon put her on the kitchen table and performed the first known operation to remove gallstones. The patient recovered uneventfully. The patient was the surgeon’s own mother.

When Halsted went to medical school, surgeons still operated in street clothes, with bare hands, and major surgical procedures carried a mortality rate of nearly 50 percent. Suppuration of wounds was called laudable pus. Lister had recently introduced carbolic acid dips and sprays (that were irritating and toxic), but hand washing was discouraged because it was thought to force germs into skin crevices. (more…)

In 1925, Francis Peabody famously said “The secret of the care of the patient is in caring for the patient.” A new book by Norman Makous, MD, a cardiologist who has practiced for 60 years, is a cogent reminder of that principle.

InTime to Care: Personal Medicine in the Age of Technology, Dr. Makous tackles a big subject. He attempts to show how modern medicine got to where it is today, what’s wrong with it, and how to fix it. For me, the best part of the book is the abundance of anecdotes showing how medicine has changed since Dr. Makous graduated from medical school in 1947. He gives many examples of what it was like to treat patients before technology and effective medications were introduced. He describes a patient who died of ventricular fibrillation before defibrillators were invented, the first patient ever to survive endocarditis at his hospital (a survival made possible by penicillin), a polio epidemic before polio had been identified as an infectious disease, the rows of beds in the tuberculosis sanitariums that no longer exist because we have effective treatments for TB. He tells funny stories: the patient who was examined with a fluoroscope and told the doctor he felt much better after that “treatment.” He describes setting up the first cardiac catheterization lab in his area. No one who reads this book can question the value of scientific medicine’s achievements between 1947 and 2010. Today we can do ever so much more to improve our patients’ survival and health. But in the abundance of technological possibilities, the crucial human factor has been neglected.

Individualized care, which involves the use of science-inspired technology, is not personal care. Alone, it is incomplete. It does not provide the necessary reassurance that can only be provided through a trusted physician who focuses upon the totality of the person and not just upon a narrow technological application to a disease. Time and personal commitment are needed to build the mutual understanding and trust that are fundamental to personal care….the continued acceleration of science, technology, and cost has intruded on personal care in our country. This has also occurred during a time in which American individualism and its accompanying sense of entitlement have become more of a cult than ever before. In the absence of personal attention, patients demand more testing, but testing does not satisfy the need for personal interaction.

Makous invokes the Golden Rule: “Over the course of my career, I learned to treat patients as I would like to be treated under similar circumstances.” (more…)

A “Double Standard”?

Last week I had planned to write a comprehensive critique of a recent comment by Larry Dossey. He had posted it on Val Jones’s betterhealth website in response to Dr. Val’s essay, “The Decade’s Top 5 Threats To Science In Medicine,” originally posted here on SBM. Much of what Dr. Val had identified as the top threats involved recent dalliances, by government, medical schools, and the media, with the collection of implausible and mostly nonsensical health claims that advocates have dubbed “CAM.” As uncontroversial as Dr. Val’s assertions ought to have been—similar to suggesting that closing one’s eyes and “using the force” would be a threat to safe driving (even if some might quibble over the top threats to science in medicine)—Dr. Dossey demurred by distraction:

Your article implies that conventional medicine is grounded in evidence-based research and that CAM is not. This is grossly overstated, and suggests that a double standard is being applied to these fields.

Dossey trotted out familiar arguments: “Much, if not most, of contemporary medical practice still lacks a scientific foundation”; “the Congressional Office of Technology Assessment (OTA) found that only an estimated 10 to 20% of the techniques that physicians use are empirically proven”; hospital care is “the third leading cause of death in the United States,” accounting for hundreds of thousands of deaths each year.

He concluded with an appeal to fairness, rationality, and collegiality:

Overwhelming evidence reveals that conventional medicine is, on the whole, woefully unscientific. It’s fashionable and easy to deny this, but the facts say otherwise. So, by all means, Dr. Val, be critical of CAM – but do not fall into a double standard. Let us ruthlessly apply science to ALL we do as physicians. Let us challenge ALL areas of medicine to a higher standard. On that, I’m pretty sure we can agree.

Keep up the good work.

Sincerely yours,
Larry Dossey, MD

I procrastinated with my own rebuttal, and in the meantime David Gorski responded to similar language found in an article by Dossey (and two other magical thinkers) titled “The Mythology of Science-Based Medicine,” published by the Huffington Post. I’ll not repeat Dr. Gorski’s able rebuttal in any detail, and I’ve already written about much of what this matter brings to mind. Examples are here, here, and here on the perils of conflating science-based medicine and Evidence-Based Medicine (EBM); here on the false dichotomy of modern medicine vs. “CAM”; here on a concise definition of “CAM”; here and here on the mischief spawned by demands to “ruthlessly apply science,” in the narrow, EBM sense of the word, to implausible health claims; here (point #7) and here regarding the tu quoque fallacy, the “10-20% empirically proven” claim, and the risks of modern health care; here (scroll down to “this week’s entry”) and here, regarding some of Dossey’s own opinions about science and the future of medicine.

For now I’ll elaborate on a few points. These pertain not only to Dr. Dossey but also to myths common to the advocacy of pseudomedicine, so I hope to provide some useful information.

On 10/08/09, the NIH and Science through press releases announced the following remarkable information: Consortium of Researchers Discover Retroviral Link to Chronic Fatigue Syndrome (CFS.) From Science on line:

Scientists have discovered a potential retroviral link to chronic fatigue syndrome, known as CFS, a debilitating disease that affects millions of people in the United States. Researchers from the Whittemore Peterson Institute (WPI), located at the University of Nevada, Reno, the National Cancer Institute (NCI), part of the National Institutes of Health, and the Cleveland Clinic, report this finding online Oct. 8, 2009, issue of Science.

“We now have evidence that a retrovirus named XMRV is frequently present in the blood of patients with CFS. This discovery could be a major step in the discovery of vital treatment options for millions of patients,” said Judy Mikovits, Ph.D., director of research for WPI and leader of the team that discovered this association. Researchers cautioned however, that this finding shows there is an association between XMRV and CFS but does not prove that XMRV causes CFS.

I will write occasional posts instead of being on a regular schedule. The reasons: There are more contributors than positions. Newer people to the field have more ambition and belly fire. I have a number of projects and papers to finish in increasingly limited time and decreasing efficiency. So have at it. Meanwhile, some non-random thoughts.

I am as concerned with social and political expression of pseudoscience as with its errors. Health care reformers can be just as pseudoscientific as sectarians who want to restructure the scientific edifice. Political ideologues want to centralize the medical system without solid evidence that their substitute would work, let alone work better. Sectarians already see a national government system as an opportunity for expansionism. Mark Hyman, the Functional Medicine promoter, met with the White House staff, displaying his vision of medicine under a federal plan. Word is out that other sects have also had input. Many hold suspicions that the proposals front for more ambitious formulations. I am suspicious of their confidence – that they can fix a complex, fluxing system using epidemiology, mathematical models, treatment paradigms, and top-down control. I might accept some proposals if it were not that all constructed systems are intrinsically inefficient, political, and corruptible. The closer the agents of control are to the controlled, the more control the controlled have over the controllers – if you can follow that.(more…)

The following is the second adapted excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. This section argues that the current flurry of interest in acupuncture and Oriental Medicine stems predominantly out of postmodern opposition to Enlightenment rationalism, and bears witness to Orientalism and consumerism in contemporary medicine.

Although acupuncture has been known in the US since the 19th Century, its therapeutic claims were dismissed or judged to be “much overrated” by the medical community.2,3 Nonetheless, the publication of a report in the New York Times by James Reston, a reporter in President Nixon’s press corps who hadreceived acupuncture for postoperative cramps in Beijing in 1971 changed this perception, and triggered a flurry of interest amongst the American public and some in the medical community.4 Within the following months, journalists, scientists and physicians rushed to China to withness this peculiar phenomenon, which the popular press and a few scientific journals sensationalized by reporting that thousands of successful operations of all sorts were being carried out in PRC using acupuncture anesthesia; some elaborated on its widespread use for a myriad of conditions, to include paralysis and deafness!5

These unconfirmed claims in the heady social and intellectual climate of the 1970s–meaning the American Counterculture; the rejection of mainstream values, beliefs and ideals; the youth movement, nonconformism and the hippie subculture, the belief in a “New” and “Cosmic” consciousness and the cult phenomenon; revolutionary ideas mixed with environmentalism; organic farming and the avoidance of pollution, agrochemicals and pharmaceuticals; nonconformism and alternative lifestyles; a syncretistic mix of psychedelic drugs, Eastern religions and Native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;6,7 and the belief in the existence of a separate and non-ordinary reality, as upheld by one of the fathers of the New Age movement, Carlos Castaneda8–gave the justification to view acupuncture as a “heal all” therapy based on alternate perceptions of health and disease. This amalgamation happened precisely when a whole generation of disenchanted Westerners were eager to find novel solutions for their existential predicaments; one that would be free from the constraints of the so-called “repressive rationality” of modern science in “overdeveloped” societies.9,10. Most Western publications on acupuncture therefore fostered the belief that Eastern healing arts have crucial characteristics directly and unequivocally opposite to the repressive rationalism of the West.(more…)

One of the fathers of critical thinking and skeptical inquiry, the French philosopher Bernard le Bovier de Fontenelle (1657–1757) recounts in 1687 in his Histoire des oracles–a debunking book on popular beliefs, myths and superstitions that caused tremendous stir in theological and philosophical circles of his time–a colorful story that could very well illustrate the flurry of interest and research in acupuncture that followed a 1971 anecdotal account of its use in China, and the plethora of verbiage and publications that ensued. If the story of the Tooth of Gold is comical, colorful and amusing, its applicability to acupuncture is not.

In 1593, the rumor ran that a seven year old in Silesia grew a tooth of gold in place of one of the cheek tooth he lost. Horatius, professor of medicine at the University of Helmstad, wrote a history of this tooth in 1595 and alleged that it was partially natural, partially miraculous, and that it was sent by God to this child to console the Christians that were oppressed by the Turks. Just imagine what consolation and what concern this tooth might bring to the Christians or to the Turks. For this tooth not to lack historians, Rullandus rewrote its history in the same year. Two years later, Ingolsteterus, another learned man, wrote against the views of Rullandus on the tooth of gold; to which Rullandus immediately wrote a fine and wise reply. Another great man named Libavius gathered all that had been written on this tooth and added his own views. Nothing lacked to these many fine books, other than the tooth were truly of gold. When the goldsmith examined it, he found that it was made of a leaf of gold skillfully applied to the tooth; but they began by writing books and then they consulted the goldsmith.1

Translated from French by the author

Besides the glut of popular publications on Chinese acupuncture and medicine by wishful authors without any training in biomedical sciences and healthcare, the NIH, the NCCAM, and some of our most prodigious medical universities also have official and academic publications on the subject that too well resemble the fine and wise publications of Horatius and his contemporaries. They also began by writing books and articles on the theories that could explain the purported indications of acupuncture, and then they assessed the veracity these indications in clinical trials and according to the principles of evidence-based medicine.(more…)

EDITOR’S NOTE:Because, for the first time in a year and a half, both professional and personal responsibilities precluded my producing a post for Science-Based Medicine, today is the perfect time to present a guest post by Ben Kavoussi. Ben is a medical informatician with an interest in the scientific evaluation of CAM, as well as a Captain in the Army Medical Service Corps. He also studied to become an acupuncturist himself, and his article is a fascinating look at some little known history behind acupuncture that strongly suggests that it is more akin to astrology than you may be aware of. Certainly I had been unaware of it, and I bet most of our readers are unaware of it, too.

Enjoy!

I’ll be back with a post here next week at the latest.

Acupuncture is astrology with needles

by Ben Kavoussi, MS, MSOM, LAc

The following is an excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytic and impartial manner. It argues that if the effects of “real” and “sham” acupuncture do not significantly differ in well-conducted trials, it is because traditional theories for selecting points and means of stimulation are not based on an empirical rationale, but on ancient cosmology, astrology and mythology. These theories significantly resemble those that underlined European and Islamic astrological medicine and bloodletting in the Middle-Ages. In addition, the alleged predominance of acupuncture amongst the scholarly medical traditions of China is not supported by evidence, given that for most of China’s long medical history, needling, bloodletting and cautery were largely practiced by itinerant and illiterate folk-healers, and frowned upon by the learned physicians who favored the use of pharmacopoeia.

Heaven is covered with constellations, Earth with waterways, and man with channels.

Yellow Emperor’s Canon of Medicine (黄帝内经, huang di nei jing)1

Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices.2,3 The Neolithic origin hypothesis is supported by the presence of nonfigurative tattoos on the Tyrolean Ice Man–an inhabitant of the Oetztal Alps in Europe–whose naturally preserved 5,200-year-old body displays a set of small cross-shaped tattoos that are located significantly proximal to classical acupuncture points. Medical imaging shows that the middle-aged man suffered from lumbar arthrosis and the cross-shaped tattoos are located at points traditionally indicated for this condition.4,5 Similar nonfigurative tattoos and evidence of therapeutic tattooing, lancing and blood ritual have been found throughout the Ancient world, including the Americas.6,7,8 Health-related tattoos are still prevalent in Tibet, where specific points on the body are needled with a blend of medicinal herbs in the dyes. These practices appear to be largely intended to maintain balance with the natural and spiritual worlds, and also to protect against demonic infestation and malevolence. Seemingly, this Neolithic and Bronze Age lancing heritage, which was intertwined with magic and animism, has evolved in various cultures into codified systems of lancing and venesection for assuring good health and longevity. In addition to treating the impurity or superabundance of blood, in various cultures lancing was also believed to affect the flow of a numinous life-force that is, for instance, called qi (or chi, 氣, pronounced “chee”) in Chinese, prāna (प्राण) in Sanskrit, pneuma (πνεύμα) in Greek, etc.9 In many instances, elements of metaphysics, mythology, mysticism, magic, shamanism, exorcism, astrology and empirical medicine intimately intertwined, making it difficult for modern scholars to interpret them as mutually exclusive categories.(more…)